Ondansetron for anxiety

Pharmacotherapeutic group: Bronchodilator.

ATC code: R03DA05

Pharmacological action

Pharmacodynamics

The drug inhibits phosphodiesterase, increases the accumulation of cAMP in tissues, blocks adenosine (purine) receptors; has the ability to inhibit the transport of calcium ions through the channels of cell membranes, reduces the contractile activity of smooth muscles. Relaxes the muscles of the bronchi, relieves bronchospasm. It has a moderate inotropic and diuretic effect. Eufillin lowers vascular resistance, reduces the tone of blood vessels (mainly the vessels of the brain, skin and kidneys), dilates coronary vessels, lowers pressure in the pulmonary artery system, improves diaphragm contraction, increases mucociliary clearance, inhibits the release of mediators (histamine and leukotrienes) from obese cells, stimulates the respiratory center, increases the release of adrenaline by the adrenal glands, inhibits platelet aggregation, improves microcirculation. nine0008

Pharmacokinetics

Bioavailability for liquid dosage forms - 90-100%. The time to reach the maximum concentration in blood plasma with intravenous administration of 0.3 g is 15 minutes, the maximum concentration in blood plasma is 7 μg / ml. 60% of eufillin (in healthy adults) and 36% (in newborns) binds to plasma proteins and is distributed in the blood, extracellular fluid and muscle tissue. Eufillin penetrates into breast milk (10% of the accepted dose), through the placental barrier (the concentration in the fetal blood serum is slightly higher than in the mother's serum), does not accumulate in adipose tissue. nine0% of the drug is metabolized in the liver. Metabolites are excreted by the kidneys, 7-13% of the drug is excreted unchanged. The elimination half-life is 5 to 10 hours in non-smoking adults and 2.5 to 5 hours in children older than 10 months. Smoking and alcohol significantly affect the metabolism and excretion of the drug, in particular, in smokers this period is significantly reduced and ranges from 4 to 5 hours. The elimination of the drug is prolonged in patients with respiratory failure, with hepatic and heart failure, with viral infections and hyperthermia. nine0008

Indications for use

Broncho-obstructive syndrome in bronchial asthma, bronchitis, pulmonary emphysema, hypertension in the pulmonary circulation.

Ischemic cerebrovascular accident (as part of combination therapy to reduce intracranial pressure).

Left ventricular failure with bronchospasm and respiratory failure of the Cheyne-Stokes type (as part of complex therapy).

Dosage and administration

Intravenously.

5-10 ml of a 2.4% solution (0.12-0.24 g) is slowly injected into a vein in adults (over 4-6 minutes), which is first diluted in 10-20 ml of isotonic sodium chloride solution. When palpitations, dizziness, nausea appear, the rate of administration is slowed down or switched to drip administration, for which 10-20 ml of a 2. 4% solution (0.24-0.48 g) is diluted in 100-150 ml of isotonic sodium chloride solution; administered at a rate of 30-50 drops per minute. Eufillin is administered parenterally up to 3 times a day, no more than 14 days. nine0008

The highest doses of aminophylline for adults in a vein: single - 0.25 g, daily 0.5 g.

The drug is not recommended for children under 14 years of age due to side effects.

However, if necessary, children are administered eufillin intravenously at the rate of a single dose of 2-3 mg/kg, preferably by drip.

Higher doses for children intravenously: single - 3 mg / kg, daily - under the age of 3 months. - 0.03-0.06 g, from 4 to 12 months. - 0.06-0.09 g, from 2 to 3 years - 0.09-0.12 g, from 4 to 7 years - 0.12-0.24 mg, from 8 to 18 years - 0.25 -0.5 g.

Contraindications

Severe arterial hypotension or hypertension, paroxysmal tachycardia, extrasystole, myocardial infarction with cardiac arrhythmias, epilepsy, increased convulsive readiness, hypertrophic obstructive cardiomyopathy, thyrotoxicosis, pulmonary edema, severe renal coronary and/or hepatic insufficiency, hepatic insufficiency , hemorrhagic stroke, retinal hemorrhage, bleeding in a recent history, hypersensitivity to the drug to the drug (including other xanthine derivatives: caffeine, pentoxifylline, theobromine). nine0008

Precautions: pregnancy, neonatal period, age over 55 and uncontrolled hypothyroidism (possibility of cumulation), sepsis, prolonged hyperthermia, gastroesophageal reflux, prostatic hyperplasia, widespread vascular atherosclerosis, patients with severe liver and kidney dysfunction , peptic ulcer of the stomach and 12 duodenal ulcer (history).

Use caution when consuming large amounts of caffeinated foods or drinks during treatment. nine0008

Side effects

From the digestive system: gastroesophageal reflux, heartburn, exacerbation of gastric and duodenal ulcer, gastralgia, diarrhea.

From the side of the central nervous system: - headache, anxiety, anxiety, irritability, dizziness, rarely - convulsions, nausea, vomiting, insomnia, tremor.

From the side of the cardiovascular system: palpitations, tachycardia (including in the fetus when taken by a pregnant woman in the third trimester), cardialgia, an increase in the frequency of angina attacks, cardiac arrhythmia, a decrease in blood pressure up to collapse - with fast in / in the introduction. nine0008

Allergic reactions: exfoliative dermatitis, fever.

Local reactions: induration at the injection site - hyperemia, soreness.

Other: flushing, increased diuresis, chest pain, tachypnea, albuminuria, hematuria, hypoglycemia, increased sweating, skin rash, skin itching.

Drug interactions

In combination with phenobarbital, phenytoin, rifampicin, isoniazid, carbamazepine or sulfinpyrazone, a decrease in the effectiveness of aminophylline is observed, which may require an increase in the doses of the drug used. The clearance of the drug is reduced when it is used in combination with antibiotics of the macrolide group, lincomycin, allopurinol, cimetidine, isoprenaline, enoxacin, beta-blockers, which may require a dose reduction. Ephedrine and caffeine enhance the effect of the drug. With simultaneous use with small doses of ethanol, disulfiram, fluoroquinolones, recombinant interferon alpha, methotrexate, mexiletine, propafenone, thiabendazole, ticlopidine, verapamil, and with influenza vaccination, the intensity of the action of aminophylline may increase, which may require a reduction in its dose. Enhances the action of beta-agonists. nine0008

Oral estrogen-containing contraceptives, antidiarrheals, intestinal sorbents weaken, and H ₂ - histamine blockers, blockers of "slow" calcium channels enhance the action (bind to the cytochrome P450 enzymatic system and slow down metabolism) of aminophylline. The use of beta-blockers interferes with the bronchodilating effect of eufillin and can cause bronchospasm. Eufillin potentiates the action of diuretics by increasing glomerular filtration and reducing tubular reabsorption, reduces the effectiveness of lithium preparations. With caution, aminophylline is used simultaneously with anticoagulants, with other derivatives of theophylline or purine. nine0008

Increases the likelihood of developing side effects of CNS stimulants (increases neurotoxicity), glucocorticosteroids, mineralocorticosteroids (hypernatremia), general anesthetics (increased risk of ventricular arrhythmias). Compatible with antispasmodics. The drug is incompatible with a solution of glucose, fructose and levulose. The pH of the solutions to be mixed should be taken into account: pharmaceutically incompatible with acid solutions.

Special instructions

Before parenteral administration, the solution must be warmed to body temperature. The drug is prescribed with caution to patients with severe violations of the liver and kidneys, peptic ulcer of the stomach and duodenum.

Elderly patients are advised to reduce the dose of the drug due to its delayed excretion from the body. Smoking patients are advised to increase the dose due to the accelerated excretion of the drug from the body.

Use during pregnancy and lactation

If it is necessary to prescribe the drug during pregnancy and lactation, the expected benefit to the mother and the potential risk to the fetus or newborn should be compared. If necessary, the use of the drug during lactation, breastfeeding should be discontinued.

Influence on the ability to drive vehicles, mechanisms . nine0008

Keep out of the reach of children and do not use after the expiration date.

Overdose

Symptoms: loss of appetite, gastralgia, diarrhea, nausea, vomiting (including with blood), gastrointestinal bleeding, tachypnea, flushing of the skin of the face, tachycardia, ventricular arrhythmias, insomnia, motor agitation, anxiety, photophobia, tremor, convulsions. In severe poisoning, epileptoid seizures can develop (especially in children without any precursors), hypoxia, metabolic acidosis, hyperglycemia, hypokalemia, lowering blood pressure, skeletal muscle necrosis, confusion, renal failure with myoglobinuria. nine0008

Treatment: withdrawal of the drug, forced diuresis, hemosorption, plasmasorption, hemodialysis (low efficiency, peritoneal dialysis is ineffective), symptomatic therapy (including metoclopramide and ondansetron for vomiting). If convulsions occur, maintain airway patency and carry out oxygen therapy. For the relief of a seizure - intravenous diazepam, 0. 1-0.3 mg / kg (but not more than 10 mg). For severe nausea and vomiting, metoclopramide or ondansetron (iv).

⚓ All About Seasickness

Differences in resistance to seasickness depend on ship size, sea conditions and sailing experience. Thus, if the provocative movement is active for a long time (for example, on board a ship during a storm), then in most people the degree of manifestations of motion sickness gradually decreases as they adapt to the rocking. The dynamics of this adaptation, as well as other characteristics of motion sickness, has individual differences, however, as a rule, noticeable adaptation occurs on the second or third day of swimming, and by the fourth, all symptoms usually completely disappear. Seasickness is rare among professional sailors. This is due to strict professional selection and training of the vestibular apparatus during training and subsequent work. But sometimes a person cannot adapt to rolling on a ship, even for a long sea service. The famous English naval commander Admiral Nelson spent many years at sea and, nevertheless, every time during a storm he suffered greatly from this disease. Approximately 5% of people do not adapt to rolling at sea at all, and they are subject to motion sickness throughout their lives. Persons with innate stability adapt more quickly to provoking accelerations. nine0224 Among other factors influencing the resistance to seasickness, personality traits (extroverts are more resistant than introverts), motivation, emotionality and activity of the central nervous system, as well as fear and anxiety are of great importance.
So how can the unpleasant symptoms associated with seasickness be alleviated or prevented? First of all, it is necessary to limit head movements to a minimum, which affect the development of motion sickness, this is well known. You can limit the movement of your head arbitrarily, but it is better if it rests on an appropriate support - a headrest, roller, etc. It should be remembered that on board a ship experiencing motion, seasickness will be less pronounced with acceleration acting along the longitudinal axis of the head than along its anteroposterior axis. nine0224 It may be useful during swimming to reduce visual-vestibular mismatch. For example, while on a ship, at the first signs of motion sickness, it is advisable to sit with your eyes closed or fix your gaze, as noted above, on the horizon line or visible land.
A tried and tested remedy for nausea is a lemon, a slice of which should be put into the mouth as soon as possible at the first sign of seasickness. Less effective but still helpful are menthol caramel, chewing gum, spices, or anything acidic. It is good if the cabin smells of mint or pine needles (preferably the use of flavors). nine0224 Breakfast (lunch, dinner) before going to sea should be light, because both a full stomach and an empty stomach are an additional burden on the body. From food on the road, choose low-fat and hot food. Soda water, cake or cake with a lot of cream are not for you. It is useful to wipe the neck and temples with a damp towel. Hand massage will also help: put one hand on your knee, palm up. Gently massage under the wrist with the thumb of the other hand, and then the middle of the palm with the index and thumb. nine0224 If a person experiences seasickness precisely in the expanses of water, then during pitching, proper breathing helps: the deck lowers - inhale, rises - exhale.
In the long term, various types of vestibular training can be the most effective means of preventing seasickness: special physical and gymnastic exercises, volleyball, swimming, acrobatic trampolining, exercises on sports equipment: the Rhine wheel, triplex, etc. For passive - a swivel chair , swing, etc. With combined methods, active and passive exercises are combined. Such training not only contributes to the suppression of unpleasant vestibular reactions, but also improves orientation in space. nine0224 Active vestibular training is carried out daily in the morning before meals (eyes should be open when performing). All head movements are performed at a fast pace (approximately 120 per minute) for one minute, and after 30 seconds of movement, a pause of 5 seconds should follow. The whole set of exercises takes 8 minutes.
Starting from the first exercise, the complex is repeated and, if you feel well, perform for another eight minutes. At the end of the workout, you need to rest for two to three minutes. nine0224 The duration of the first classes is two minutes, and it is advisable to carry out the exercises while sitting. Subsequently, with each lesson, the training time should be increased by one to two minutes and, starting from the third to fifth lesson, movements should be performed in a standing position.
During training, coordination disorders (up to a fall) are possible, for the prevention of which it is necessary to provide insurance to the practitioner. If some people have pronounced vestibulo-vegetative reactions (severe pallor, sweating, nausea, etc.), the session must be stopped. nine0224 In recent years, for the prevention of seasickness, methods of psychoprophylaxis and psychotherapy, autogenic training with training in self-control of some vegetative reactions, using biofeedback, which allows you to control, prevent or weaken the manifestations of motion sickness, have begun to be used.
A large role in the prevention and relief of seasickness is assigned to pharmacological agents, the number of which is currently significant.
It should, however, be remembered that almost all drugs used as a means of preventing and relieving motion sickness have their own indications and contraindications. Therefore, before taking this or that drug with you on a trip, you must carefully read the corresponding instructions for its use. And be sure to test it on yourself even before the start of the sea voyage for individual intolerance. nine0008

Most often, so-called antihistamines are used to combat kinetosis - diphenhydramine, suprastin, pipolfen. Many of these drugs are familiar as allergy drugs, and the fight against motion sickness is “part-time work” for them. True, for some of these drugs, it becomes the main one. Aviomarin, bonin and kinedril are only sold as motion sickness remedies.

Kinedryl stands out a little in this group: in addition to the antihistamine, it also contains caffeine. And this supplement allows you to reduce the "inhibitory" effect of the antihistamine component - to reduce lethargy and drowsiness. But even despite the invigorating caffeine, kinedril could not completely get rid of the soporific effect. nine0008

It should be remembered that antihistamines do not act immediately (after 2 hours or more), but for a relatively long time. Bonin has a particularly long-lasting effect - up to 12 hours. Therefore, this group of medicines should be taken at least one hour before the trip.

Fast-acting drugs containing belladonna alkaloids can be referred to. Among them is such a well-known drug as Aeron, and not so often used Bellataminal and Bellaspon.

Among the official fighters against motion sickness there are also homeopathic preparations - domestic air-sea and German vertigoheel. These drugs act according to the classic homeopathic principle "like cures like": they contain those components that provoke symptoms typical of motion sickness - nausea, vomiting, dizziness. But thanks to meager doses, they have a curative, not provocative effect. nine0008

A biologically active supplement "Companion" has recently appeared. This is also an effective remedy for motion sickness, containing natural plant products - peeled ginger rhizome and chamomile flowers. You need to take it 1-2 tablets 30 minutes before the trip. By the way, ginger has long been used by sailors. Chinese sailors chewed it to reduce seasickness.

None of these drugs available? Validol or Valocordin can help: they can be used as sedatives and antiemetics. Peppermint tea or peppermint extract can help in this situation. nine0008

To help people overcome seasickness or airsickness, pharmacologists have invented many remedies. But most of them have many contraindications and side effects. Natural remedies for motion sickness are absolutely safe, but at the same time they are no less effective than drugs.

Homeopathy
The best homeopathic remedy for motion sickness is Nux Vomica. The standard dosage for adults is 10 drops or 3-5 grains to be taken before boarding a vehicle. You can buy Nux Vomica at any homeopathic pharmacy. This component is also part of the complex preparations - the Russian "Avia-Sea" or the German Nux Vomica-Homaccord. nine0008

Ginger root
In ancient times, Asian sailors had a habit of chewing ginger during long sea voyages. In the early 1990s, scientists from the US Herbal Medicine Research Laboratory in Salt Lake City decided to test the effectiveness of this ancient custom and conducted an experiment with 36 volunteers who suffered from motion sickness. It turned out that the effectiveness of ginger root powder is superior to known pharmacological drugs for motion sickness. To get rid of seasickness, take one gram of dried ginger root powder before you travel. If you feel nauseous during the trip, it is worth "upping the dose" - drink some ginger beer or eat a couple of gingerbread cookies. Ginger caramels are also suitable - after taking them, do not brush your teeth or rinse your mouth for a while. nine0008

Acupuncture
Another piece of advice borrowed from sailors. Before the trip, you need to carefully, but tightly enough, tighten your wrists with elastic bandages, which are sold in any pharmacy. This simple measure will create a pressure drop that will save you from discomfort while traveling. In addition, the bandages will constantly act on a special point in the wrist area, which will help overcome nausea. If you are still seasick, for several minutes rhythmically press with a fingernail or a match on another point under the earlobe. nine0008

Proper nutrition
Before a trip, you should neither starve nor indulge in gluttony. The best option is a small amount of lean protein food such as cottage cheese or a piece of fish. During the trip, especially if you are flying by plane, it is better to refresh yourself with food that you have brought from home in advance. On board, they usually offer quite fatty and sweet food, which can only worsen the condition. Therefore, the best option would be to take a bottle of drinking yogurt or kefir with you, a small portion of cold boiled chicken or turkey. Especially salty and sour foods help to cope with motion sickness. Therefore, during the trip, you can enjoy, for example, pickled herring, various pickles. Remember only that food should be taken in very small portions. nine0008

Cold compress
Scientists have shown that an ice pack applied to the head and neck during travel can significantly reduce the intensity of unpleasant symptoms, especially nausea. Ice can be replaced with a damp, cold cloth. This method is especially effective in combination with a warm heating pad on the feet.

Inner mood
An important factor is your mood and behavior during the trip. First, before the trip, convince yourself that this time you definitely won’t get seasick. Focus your eyes on some fixed object or horizon line. Try to provide yourself with constant access to a source of fresh air.

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